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241 Crosswind Dr Lot 3 DAVIE COUNTY HEALTH DEPARTMENT IMPROVEMENTS PERMIT AND .CERTIFICATE OF COMPLETION *NOTE:Issued in Compliance With Article II of G.S.Chapter 130a ,�q Sanitary SewageSystems Permit um"ber Name 112-\\ .�� �.�% `! ._� '_ c a`r► Date , ; 1 NO Location Subdivision NameLot No. Seca or Block No. Lot Size -~ r) House Mobile Home — Business Speculation No. Bedrooms No. Baths No. in Family `y Garbage Disposal YES p/ NO ❑ Specifications for System: Auto Dish Washer YES p/ NO ❑ 0 D p Auto Wash Ma,hine YES p/ NO ❑ Type Water Supply *This permit Void if sewage system described below is not installed within 5 years from date of issue. This permit is subject to revocation if site plans or the intended use change. -------------------------- i .. .r Improvements permit by -'— *Contact a representative of the Davie County Health Department for final inspectltin–of this system between 8:30- 9:30 A.M. or 1:00-1:30 P.M. on day of completion. Telephone Number 70 34-5985. Final Installation Diagram: Syste� Installed lou !a Certificate of Completion Date "The signing of this certificate shall indicate that the system described above has been installed in compliance with 9 9 the standards set forth in the above regulation, but shall in NO way be taken as a guarantee that the system will function satisfactorily for any given period of time. r ? APPLICATION FOR SITE EVALUATION/IMPROVEMEN S PER IT L Davie County Health Department ev_ � - Environmental Health Section N P. O. Box 665 ti Mocksville, NC 27028 c w — 1. Application/Permit Requested By Phi )(J —�et'f t ES PV Mailing Address Rte)you E r k:�n LIC 22 0 0(p Home Phone `"1 19 - g1QBusiness Phone 2. Name on Permit if Different than Above 3. Application/Permit for: ❑ General Evaluation WSeptic Tank Installation, 4. System to Serve: House ❑ Mobile Home ❑ Place of Public Assembly ❑ Business ❑ Industry ❑ Other ❑ Unknown 5. If house, mobile home: Subdivision Section Lot # ❑ Basement/Plumbing No. of People 3 ❑ Basement/No Plumbing No. of Bedrooms -1 �3 Washing Machine No. of Bathrooms 5, ❑'Dishwasher Dwelling Dimensions CaQf6 X 3(Qoo �Srq- . - Garbage Disposal 6. If business, industry, place of public assembly, other: Specify type No. of People Served No. of Sinks No. of Commodes No. of Urinals No. of Lavatories No. of Water Coolers No. of Showers Water Usage Figures 7. Type of water supply: Public ❑ Private ❑ Community 8. Property Dimensions 6 •a Sewage Disposal Contractor 9. Do you anticipate additions/expansion of the facility this sytem is intended to serve? ❑ Yes [ lA If yes, what type? 'NOTE: Improvements Permits shall be valid for a period of 5 years from date issued. Improvements Permits are subject to revocation, if site plans or the intended use change. Effective October 1, 1989. Directions to Property: Wo 4AUOLV)OL ova �'e -�G� a�� 1 � or�o CC'o SS Lem �►'1C� 5 SA-ra�V- C\-.eaa This is to certify that the information provided is correct to the best of my knowledge and I understand I am responsible for all charges incurred from this Pp ii ation. �� 4 , aL DATE SIGNATURE CONSENT FOR SITE EVALUATION TO BE DONE ON ABOVE DESCRIBED PROPERTY Fandd ECK ONE: ❑ 1. I OWN the property. ❑ 2. I DO NOT OWN the property. ked Box#2, the rest of this form MUST be completed by the owner or a person authorized by the owner: ve consent to the authorized representative of the Davie County Health Department to enter upon above described cated in Davie County and owned by all testing procedures as necessary to determine said site's suitability for a ground absorption sewage treatment al system. DATE SIGNATURE DCHD(12-90) ,j DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section Soil/Site Evaluation N}ttME V\\-X\ > s R DATE EVALUATED ADDRESS SP`m° PROPERTY SIZE E.1 PROPOSED FACIILTY o S LOCATION OF SITE Water Supply: On-Site Well Community Public (/ Evaluation Byl�.�L Auger Boring V Pit Cut FACTORS 1 2- 3 - 4 Landscape position S ,S Sloe S ' 15 ted- 5 HORIZON I DEPTH Texture krou2 t L S C L >C L C L Consistence Structure �� �li_� NineralogX HORIZON II DEPTH 36 3 3 a Texture groupC C C e - Consistence Structure li� g K Mineralogy J J / : 1 HORIZON III DEPTH Texture group Consistence Structure Mineralogy HORIZON IV DEPTH Texture group Consistence Structure Mineralogy SOIL WETNESS 5 RESTRICTIVE HORIZON SAPROLITE CLASSIFICATION S �S LONG-TERM ACCEPTANCE RATE L� SITE CLASSIFICATION: _ q S, EVALUATED BY: LONG-TERM ACCEPTANCE RATE: t� OTHER(S) PRESENT: REMARKS: G �- a � LEGEND Landscape Position R-Ridge S-Shoulder L-Linear slope FS-Foot slope N-Nose slope CC-Concave slope CV-Convex slope T-Terrace FP-Flood plain H-Head slope Texture S-Sand LS-Loamy sand SL-Sandy loam L-Loam SI-Silt SICL-Silty clay loam, SIL-Silty loam CL-Clay loam SCL-Sandy clay loam SC-Sandy clay SIC-Silty clay C-Clay CONSISTENCE Moist VFR-Very friable FR-Friable FI-Firrn VFI-Very firm EFI-Extremely firm Wet NS-Non sticky SS-Slightly sticky S-Sticky VS-Very Sticky NP-Non plastic SP-Slightly plastic P-Plastic VP-Very plastic Structure SC-Single grain M-Massive CR-Crumb GR-Granular ABK-Angular blocky SBK-Subangular blocky PL-Platy PR-Prismatic Mineralogy 1:1, 2:1, Mixed Notes Horizon depth - In inches Depth of fill - In inches Restrictive horizon - Thickness and inches from land surface Saprolite - S(suitable), U(unsuitable) Soil wetness - Inches from land surface to free water' or inches from land surface to soil colors with chroma 2 or less Classification - S(suitable), PS(provisionally suitable), U(unsuitable) LTAR - Long-term acceptance rate - gal/day/ft2 DCHD(01-901 ■■■...■■■■■■■.■■■.■■..■■■■■■■.■■...■..■■...■■■■.■■■■■.■■■■ ■■AMMAN ........................... ...................................... ■.■■■■■■■■■■■■■■■■■■■■.....■.■.■ ■.■■...■.■■■■■■■■■■■■....■■■ ..■ ■■■■ANNA■■====.......i.���e■■..■.■ ■..■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■.■■..■■ii:■i_'iii■■■■.■■.■.■■■■■■■Ali■■■■■■■■■■■■ ■■■■■■■■ ■■■■■■■■■■/1101■■■■■■■■■■■■■■.■■■■■■■■■.�i:���l■■■■■■■.■■■■■■■■■■■.■ ■.■EElee���CC�GGGGi�iCGiGGC��i��C�C���������Jrt�■■.....■■■■■.■.■E..r/ ■■■■■■■■■.i■■■■■■■■■■■.■.■■■■■■■■■.■■ANNA■■■■.l■■■■■■■■■■■■■■■■■■■■■ No mooniEMEMSE w- ! ■.■■..riwu?.■wl:.e■r�.\II�I�■c� UME■■■■■■■■..■■�■■.■■■I■t■■■■■e■■■■■■■■ ■■■ ■.■l�■■i■iiL'3 V ii■■■N`■1■►`I■■�.:i■.■■..■.■!!■■.AMMAN■■.I■■■..■■■■■■.■■■■MEMO ....■..■...........■1....I�iiMME■■J....■.A....�■1�■■E■E■H.■�■■EVAN M�■ ■■■■►\■►\■%Ali:■l1,4:E■NNAME ■ ■■■..E■A■E■■!1.■■■■NENENEEI!iEENi;elnMlN■■NENIi::�rJI�NEN■■■E■NE ■ENA■NE■ ■■■■■■►■■filer`Ilial■EE■■■.1■E.'/EMEEE■M■■■■EN/....■EE ■■.■■■■■■■//ANNA■■ ■■■■■■■c.■■■■■■■■■■■■■■■■■..■■.■■iia■■■■■■■■■■■■■E.■.■.■■■■■■■■■■■■■ ■■■■■■■\N■ME■■■■.N■■.■■■■■■■■■■.:�■■■ANNA■■■■E■■.■■■■■■■■■■//■■■N■■■ EMEMMON \O�IMMMOMOM IME ...........■...............................CMM.....MMMMMKM■MMMM■■ ...........■.................... ..■■■■■_■■■■■■■■■■■■■■UMEMM..... ■■■■.■.H■■■■■\.■■■■■■■■■■■■■■■■■.■■■H.■�N.E■.EEE■■■■■//■■■■■■■■■■ ■■■■■■■■■■■■■■■■■.\■■■■■■■■■■NEN.NEE■■■■.■■■■■■■EEE ■.NE■■■■E.MEN■ ■■.■■■■■■■■■■■■■s..►�.■■■.■■�.■...■■■■■.■■■■■.■■■■■■tee■■■■■■■■■■■■■ f■a f j ECEIVED SEP 1 1 1986 APPLICATION Ferri SITE EVALUATION/IMPR VEN1t-,v 'S PERMIT Davie County Health DepartmentP: ; Environmental Health Section D '4"' P. 0. Box 665 Mocksville, N.C. 27028 DIV CONSTRUCTION SHALL NOT BEGIN UNTIL IMPROVEMENTS PERMIT HAS BEEN ISSUED. '' Home Phone gal&'1.30•s 1. Permit Requested ByZQt,.l ,'�_, Business Phone _a;5? 2. Address 3. Property Owner if Different than Above Address 4. Permit To: a) Install Alter Repair b) Privy Convention alvOther Type Ground Absorption c) Sub-Division Sec. Lot No. 5. System used to serve what type facility: House-_ZMobile Home Business Industry Other b) Number of people e 6. a) If house or mobile home, staeQN of 70�/r;u tuber i�rV�G House Dimensions SM ,� I i Bed Rooms _Bath Rooms_ Den w/Closet,,/ b) If Business, Industry or Other, State: Number of persons served What type business, etc. Estimate amount of waste daily (24 hours) 7. Number and type of w ter-using fixtures: commodes urinals garbage disposal lavatory showers -"I- washing machine dishwasher sinks e 8. a) Type water supply: Public Private Community b) Has the water supply system been approved? Yeses No 9. a) Property Dimensions—,W V ogZ4,/,�CL,c77> b) Land area designated to building site c) Sewage Disposal Contractor 10. Do you anticipate any additions or expansions of the facility this sewage system is intended to serve? o[19— What.type? This is to certify that the information is correct to the best of my knowledge. natur Owner Si Date 9 OWNER IS SOLELY RESPONSIBLE FOR COMPLIANCE WITH ALL STATE AND LOCAL LAWS Allow 5 days for processing Directions to property: 11i6,�114),4 y Via/ T® APV/)AA_7 70 G'o Ho(s.ez) ` B-� „"'r �► p�' O S39°41 E IC ,•\� r 'y/rRY ..+,T'C q ♦�y� tJh4+, / LST t l'+F� i al"f' � YNiNy xTw�„1.lk's Y'•t Y.3Yf"F"`!`� , t r � ��� � �r1• � (,,�{ter "3,�'�ih�'ti EA •10 082 r x. � � �������! •����€� d � � is r 4^ M,F � � ^'41�f•f,� • • • fl+,� r r e� �'C��,y�.hk' F A `r-�i d,J'Y°1`. ,.sem • 3 � r . :" �,,�. �t 1,*� r Ski x a � •-06N �.,...,..: • Q 1 ,30• tAON a� :572 OO•E- 11'S: *OptC • a .; .1. ae3yn }�,• Lw' 'aha , R9e �r a sus«,,'' t� • S8 ,-38 9 100o. h c , "'o 4 CRE 562*2Wri00 001+ :;:.. � . 3 7�, Q 4 • a 83ead• /�yy i7 11 - a r ,,�'"�kt4"� f'f`, t`q•+s• n' x 3ri+'* x �}}°'y ,t �' } $ M. ... `•�'�" • (i� � t Fa.i R _ tyY--� R.,,,,y'r� x. f �. • :. lk r,,r t 'F witt„�'.r'r t M1�" • r t..t"-�x' f `b a.f! rt, 7 �a.T ,,;a`Y ,•+. .A AREA 3a �a } ein {S ( a,•,ty��:. Y+�S• y� f�i8yk3Rot3 '� w k'�i-Y31�k' db Oh ' �,� ._ ... -. �� \� � � h -�y1���s bt _• +rayl i' C t Q •. - ��•. ': � fill+ �� xki:�' �U,���'�-, +1 s r�.r p -• DAAOUNTY HEALTH DEPARTMENT Environmental Health Section • P. O. Box 665 Mocksville, N.C. 27028 SOIL/SITE EVALUATION Name Date Address Lot Size FACTORS AREA 1 AREA 2 AREA 3 AREA 4 1) Topography/Landscape Position S S S S PS PS PS U U U 2) Soil Texture (12-36 in.) Sandy, S S S Loamy, Clayey, (note 2:1 Clay) PS PS PS U U U 3) Soil Structure (12-36 in.) S S S Clayey Soils PS PS PS U U U 4) Soil Depth (inches) S S S PS PS PS U U U 5) Soil Drainage: Internal S S S S PS PS PS U U U External S S S pS PS PS PS U U U 6) Restrictive Horizons 7) Available Space S S S 'PS PS PS PS U U U 8) Other (Specify) S S S S PS PS PS U U U 9) Site Classification U—UNSUITABLE S—SUITABLEPS—Provisionally Suitable—. Recommendations/Comments: Described by ,C� Title Date SITE DIAGRAM DCHD(6-82)